TECHNICAL EFFICIENCY AND TOTAL FACTOR PRODUCTIVITY GROWTH IN UGANDA’S DISTRICT REFERRAL HOSPITALS
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Date
2006-09-01
Authors
Yawe, Bruno Lule
Journal Title
Journal ISSN
Volume Title
Publisher
UNIVERSITY OF DAR ES SALAAM
Abstract
The study measures the technical efficiency and total factor productivity growth of
25 district referral hospitals from three regions of Uganda over the 1999-2003 period.
This study is motivated by a desire to evaluate the ongoing health sector reforms in
Uganda which in part are seeking to improve the efficiency of health services.
Nonparametric Data Envelopment Analysis (DEA) is used in the
measurement of hospital technical efficiency whilst the DEA-Malmquist index is
used in the measurement of hospital total factor productivity change. The Hospital
Management Information System launched in 1997 is the source of the data for this
study.
The results indicate the existence of different degrees of technical and scale
inefficiency in Uganda’s district referral hospitals over the sample period. There
were productivity losses for the sample hospitals which are largely due to
technological regress rather than technical inefficiency. Thus, changes in technology
are needed if the hospitals are to become more productive, for instance through
improved diagnosis tests, hospital information management.
The findings illustrate one of the advantages of the frontier efficiency
technique, namely the ability to identify the degree of emphasis that should be placed
on improving technical efficiency vis-à-vis technological change. The study adds to
the existing literature on health facility efficiency but additionally incorporates
patient deaths in the measurement of hospital technical efficiency. Additionally,
heterogeneity in the patient load is controlled for via a length of stay-based case-mix
index. Quality of care was incorporated into the analysis by means of patient deaths.
Super-efficiency was conducted to further distinguish between the technically
efficient hospitals. To construct confidence intervals for individual hospitals
technical efficiency scores, nonparametric bootstrapping was conducted. The
efficiency vectors yielded have ready uses by policymakers in the hospital sector.
Indicators of the relative efficiency of hospitals are needed to gauge whether hospital
cost-containment efforts are succeeding, amongst other uses.
Description
RA 410 Y38 2006
Keywords
Productivity growth , Productivity growth - Uganda